呼吸系統(tǒng)疾病(英文)課件

1、Topics Respiratory disorders Respiratory infections PneumoniaTopics Respiratory disordersRespiratory Disorders50% of consultation with general practitioners or acute illness in young children and a third of consultations in older children20-35% of acute pediatric admissions to hospital, some of whic

2、h are life-threateningAsthma is the most common chronic illness of childhoodCystic fibrosis is the most common inherited disorder in Caucasians causing chronic diseaseRespiratory Disorders50% of coRespiratory Infections The most frequent infections of childhood: 6- 8/year Pathogens:viruses,bacterial

3、, other pathogens Host and environmental factors Classification of respiratory infectionsRespiratory Infections The mosClassification of Respiratory InfectionsAccording to the level of the respiratory tree most involved: Upper respiratory tract infection Lower respiratory tract infectionClassificati

4、on of Respiratory PneumoniaEnmei LiuChildrens Hospital, CMUPneumoniaEnmei LiuCase -1C and a respiratory rate of 60 breaths/min. His chest is hyperinflated with marked intercoatal recession. On auscultation there are generalized fine crackles and wheezes. Case -1QuestionDo you have any comments or wh

5、at do you conclude anything from this case?QuestionDo you have any commenCase -1Jack, age four months, is sent at home by his general practitioner because of two days of rapid, laboured breathing and poor feeding. He was born at 27 weeks gestation, birth weight 979g and was discharged home at three

6、months of age. On examination he was a C and a respiratory rate of 60 breaths/min. His chest is hyperinflated with marked intercoatal recession. On auscultation there are generalized fine crackles and wheezes. Case -1QuestionWhat is pneumonia? QuestionWhat is pneumonia? Pneumonia is an inflammation

7、of the parenchyma of the lungs. DefinitionPneumonia is an inflammation oQuestionHow about the prevalence of pneumonia?QuestionHow about the prevalen Pneumonia accounts for approximately 15% of all respiratory tract infections. Worldwide, about 3 million children die each year from pneumonia, with th

8、e majority of these deaths occurring in developing countries. Pneumonia remains the most common cause of morbidity in China.Incidence Pneumonia accounts for approxQuestionHow to classify pneumonia in clinic?QuestionHow to classify pneum Anatomy Pathogens Severity Duration Onset siteClassification An

9、atomyClassification Bronchopneumonia Lobar or Lobular Pneumonia Interstitial PneumoniaBased on anatomy or X-ray manifestation BronchopneumoniaBased on anatBased on etiology Bacterial pneumonia Viral Pneumonia Mycoplasma Pneumonia Chlamydia PneumoniaBased on etiology Bacterial pn Acute Pneumonia Prol

10、onged Pneumonia Chronic PneumoniaBased on the process of pneumonia Acute PneumoniaBased on the p Mild Pneumonia Severe PneumoniaBased on the severity of pneumonia Mild PneumoniaBased on the se Community Acquired Pneumonia (CAP) Hospital Acquired Pneumonia (HAP)Based on the onset site of pneumonia Co

11、mmunity Acquired Pneumonia BronchopneumoniaBronchopneumoniaQuestionWhy are children likely have bronchopneumonia?QuestionWhy are children likel Characters of childhood airway anatomic structure and their respiratory physiology Immune function of childhood High risk factors: premature baby, underlyin

12、g disorders呼吸系統(tǒng)疾病(英文)課件QuestionWhat cause bronchopneumonia? QuestionWhat cause bronchopne Bacteria: Streptococcus pneumoniae, Haemophilus influenzae Viruses MycoplasmaCauses of Bronchopneumonia Bacteria: Streptococcus pnePathology of PneumoniaPathology of PneumoniaInflammaory exudateInflammaory exud

13、atePathology of PneumoniaInflammaory exudateInflammaorQuestionWhat are the pathophysiology of pneumonia?QuestionWhat are the pathophysPathogensURTIBronchitisPneumoniaInflammatory exudateObstruction of airwayGas exchange abnormalVentilation abnormalhypoxemiahypercapniatoxinemiatachypneacyanosisralesf

14、evercoughPathogensURTIBronchitisPneumonQuestionWhat are the signs and symptoms of pneumonia? QuestionWhat are the signs andThe clinical signs and symptoms of pneumonia depend primarily on the age of the patient, the causative organism, and the severity of the disease. The clinical signs and symptomF

15、everCoughCyanosisTachypeneaRalesFeverCoughCyanosisTachypeneaRa out breathing inWith inspiration, the side of the nostrils flares outwardsNasal Flaring out breathing With inspiration, the lower chest wall moves inLower Chest Wall Indrawing out breathing inWith inspiration, the lower chFeverCoughCyano

16、sisTachypeneaRalesFeverCoughCyanosisTachypeneaRa Classic findings of pneumonia that occur in adults and older children, such as fever,cough and rales, are often absent in infants and toddlers. Generally present with nonspecific signs and symptoms including lethargy, irritability, poor feeding, vomit

17、ing. If it appear respiratory failure or other abnormality of other system-severe pneumonia. Important Points Classic findings of pneumoniaComplications Empyema Pyopneumothorax Pneumatocele Lung abscesses AtelectasisComplications EmpyemaLaboratory Examination White blood cell count and C-reaction pr

18、otein Pathogens examination: 1)Sputum cultures 2)Blood cultures 3)Rapid screening tests for virus or bacterial Bronchoscopy Blood gas analysis: hypoxia and/or hypercapniaLaboratory Examination White Radiograph Evaluation Typical X-ray manifestation of bronchopneumonia is patchy infiltrates bilateral

19、ly Complication: lung abscesses, empyema, pyopneumothorax, pneumatocele, atelectasis CT Radiograph Evaluation TypicalNormal chest X-rayNormal chest X-rayPatchy infiltratesPatchy infiltratesLobar pneumonia of the right lower zone consolidation Lobar pneumonia of the right llung abscesseslung abscesse

20、spyopneumothoraxpyopneumothoraxQuestionHow to diagnosis pneumonia clinically?QuestionHow to diagnosis pneum According to the typical clinical manifestation of bronchopneumonia. According to X-ray manifestation Pay attention to the atypical manifestation of infants Evaluate the severity of pneumonia

21、Find the etiology of pneumonia According to the typical clinDifferential Diagnosis Bronchitis Foreign Body Inspiration TuberculosisDifferential Diagnosis BronchQuestionHow is pneumonia treated? QuestionHow is pneumonia treatManagement Supportive care Antimicrobials therapy Hospitalization in selecte

22、d cases Management Supportive careSupportive Care Adolescents. Respiratory care may range from oxygenation, bronchodilators for wheezing, humidification or mist, suctioning, and postural drainage, intubation and mechanical ventilation. Hydration (sometimes intravenous) Control of fever Management of

23、 complicationsSupportive Care Adolescents. Antimicrobial Therapy Adolescents. OrganismAntimicrobialS. pneumoniaePenicillin (if not resistant). third-generation cephalosporin e.g. cefotaximeceftriaxone (if resistant to penicillin)H. influenzaeAzithromycin or Amoxicillin (if not resistant)Beta lactama

24、seCefuroxime or third-generation cephalosporin (if beta lactamase and resistant)S. aureusMethicillin (if not resistant) Vancomycin (if MRSA-methicillin resistant S. aureus) if penicillin allergy: vancomycin, clindamycinChlamydiaAzithromycin (other macrolides e.g erythromycin); alternative, sulfa dru

25、gsMycoplasmaAzithromycin (other macrolides); alternative, tetracycline (if older than 8 years)RSVRibavirin (optional)InfluenzaAmantadine (if severe)BacteriaAtypicalVirusesAntimicrobial Therapy AdolesceAge GroupBacterialViralEmpiric TherapyNeonate (0-28 days)Group B streptococcus, gram-negative enter

26、ic E. coli, Klebsiella, Listeria monocytogenes, S. aureus, other gram-positive)Cytomegalovirus Herpes simplexAmpicillin and aminoglycoside (gentamicin or tobramycin or amikacin, or third- generation cephalosporin). Note: Avoid ceftriaxone 2 to bilirubin Infants 3-16 weeks; afebrile pneumonia infancy

27、Chlamydia trachomatis Ureaplasma urealyticum CytomegalovirusPneumocystis cariniiErythromycin SulfonamideInfants febrile or ill appearing age 1-3 monthsSame organisms as for neonate plus S. pneumoniae, H. influenzae, S. aureusNot applicableAntibiotic (nafcillin, oxacillin, or methacillin) Broad-spect

28、rum cephalosporin (e.g., cefotaxime)Toddler or preschool ageS. pneumoniae, H. influenzae M. pneumoniae, ChlamydiaRSV Parainfluenza Adenovirus InfluenzaAzithromycinAmoxacillin-clavulanate: not active against atypical organisms (Mycoplasma, Chlamydia) Organisms Causing Pneumonia and Empiric Therapy in

29、 Pediatric Age GroupBacterialViralEmpiQuestionHow about the clinical course of pneumonia ?QuestionHow about the clinical With treatment, pneumonia caused by bacteria can usually be cured in 1 or 2 weeks Pneumonia caused by a virus often lasts longerClinical Course Adolescents. Clinical Course Adoles

30、cents. Specific PneumoniasSpecific PneumoniasBrochiolitis Brochiolitis is the most common serious respiratory infection of infancy Two to three per cent of all infants are admitted to hospital with the disease each year during annual winter epidemics. Ninety per cent are aged 1-9 months bronchioliti

31、s is rare after one year old. Respiratory syncytial virus (RSV) is the pathogen in 75- 80% cases Brochiolitis Brochiolitis is tClinical Features Coryzal symptoms precede a dry cough and increasing breathlessness. Wheezing is often but not always present. Feeding difficulties associated with increasi

32、ng dyspnoea are often the reason for admission to hospital. Recurrent apnoea is a serious complication in infants in the first few months of life. Infants born prematurely who develop bronchopulmonary dysplasia and infants with congenital heart disease are more severely affected. The finding on exam

33、ination are characteristic: Sharp, dry cough Tachypnoea Subcostal and intercostals recession Hyperinflation of the chest Clinical Features Coryzal sInvestigations RSV can be identified rapidly using a fluorescent antibody test on nasopharyngeal secretions. The chest X-ray shows hyperinflation of the

34、 lungs due to small airways obstruction and air trapping. Blood gas analysis, which is required in only the most severe cases, shows lowered arterial oxygen and raised CO2 tension Investigations RSV can be ideHyperinflation of the lungs with flattening of diaphragmHyperinflation of the lungs wiManag

35、ement Is supportive. Humidified oxygen is delivered into a head- box Mist, antibiotics and steroids are not helpful Nebulised bronchodialators do not reduce the severity or duration of the illness The antiviral drug ribavirin only marginally shortens viral excretion and clinical symptoms, and should

36、 be considered only for infants with underlying cardiopulmonary disorders or immunodeficiency Fluids may need to be given by nasogastric tube or intravenously Mechanical ventilation is required in about 2% of infants admitted to hospital Management Is supportive. HuEtiology： Respiratory syncytial vi

37、rus (RSV) is the pathogen in 75-80% cases Clinical features: Age:3-6 monthSeasonWheezingX-ray Duration:7-10 daysManagement: BronchiolitisEtiology： Respiratory syncytiaStaphylococcus aureus . S. aureus is an uncommon but important cause of pneumonia that can occur in any age group. S. aureus is a rap

38、idly progressive fulminant illness S. aureus pneumonia easily occurs complications. Blood cultures are positive in 20-30% of patients . The pleural effusions should be drained by thoracentesis or, if large, by a chest tube. Pneumatoceles are also common and are found in 45- 60% of patients with S. a

39、ureus pneumonia. Methicillin or vancomycin should be administered for 3-4weeks. Staphylococcus aureus . S. Mycoplasma Pneumonia M pneumoniae is a common cause of symptomatic pneumonia in older children. Endemic and epidemic infection can occur. The incubation period is long (2-3weeks), and the onset

40、 of symptoms is slow. Although the lung is the primary infection site, extrapulmonary complications sometimes occur. Mycoplasma Pneumonia M pneumoClinical Features Fever, cough, headache, and malaise are common symptoms as the illness evolves. Rales are frequently present on chest examination, decre

41、ased breath sounds or dullness to percussion over the involved area may be present. Clinical Features Fever, coLaboratory findings The total and differential white blood cell counts are usually normal. The cold hemagglutinin titier should be determined, because it may be elevated during the acute pr

42、esentation. A titer of 1:64 or higher supports the diagnosis. Laboratory findings The totaImaging Chest x-rays usually demonstrate intersititial or bronchopneumonic infiltrates, frequently in the middle or lower lobes. Pleural effusions are extremely uncommon.Imaging Chest x-rays usually dComplicati

43、ons Extrapulmonary involvement of the blood, CNS, skin, heart, or joints can occur Direct Coombs-positive autoimmune hemolytic anemia,Coagulation defects and thrombocytopenia can also occur A wide variety of skin rashes including erythema multiforma and Stevens-Johnson syndromeComplications Extrapul

44、monaryTreatment Antibiotic therapy with erythromycin for 7- 10 days usually shortens the course of illness. Supportive measures, including hydration, antipyretics, and bed rest, are helpful.Treatment Antibiotic therapChlamydial Pneumonia Pulmonary disease due to C trachomatis usually evolves gradual

45、ly as the infection descends the respiratory tract. Infants may appear quite well despite the presence of significant pulmonary illness. Appropriate age: 2-12 weeks Inclusion conjunctivitis, eosinophilia, and elevated immunoglobulins can be seen. Chlamydial Pneumonia PulmonarClinical Features About

46、50% of patients with chlamydial pneumonia have active inclusion conjunctivitis or a history of it Rhinopharyngitis with nasal discharge or otitis media may have occurred or may by currently present Cough is usually present. It can have a staccato character and resemble the cough of pertussis The inf

47、ant is usually tachypenic. Scattered inspiraotrt rales are commonly heard, but wheezes rarely Significant fever suggests a different or additional diagnosis Clinical Features About 50%Laboratory findings Although patients may frequently be hypoxemic, CO2 retention is not common. Peripheral blood eos

48、inphilia has been observed in about 75% of patients. Serum immunloglobulins are usually abnormal. IgM is virtually always elevated, IgG is high in many, and IgA is less frequently abnormal. C trachomatis can usually be identified in nasopharyngeal washings using fluorescent antibody or culture techn

49、iques.Laboratory findings Although Imaging Chest x-rays usually reveal diffuse interstitial and patchy alveolar infiltrates, peribronchial thickening, or focal consolidation. A small pleural reaction can be present . Despite the usual absence of wheezes, hyperexpansion is commonly present. Imaging C

50、hest x-rays usually rTreatment Erythromycin or sulfisoxazole therapy should be administered for 14 days. Oxygen therapy may be required for prolonged periods in some patients.Treatment Erythromycin or sSummary Pneumonia in pediatric patients encompasses a wide spectrum of etiologies and illness from mild to severe and life threatening. Therapy should include an antibiotic if a bacteria or atypical bacteria (chlamydia or mycoplasma) is suspected. No antibiotics are necessary for viral pneumonia. Supportive therapy also includes fever control, maintenance of hydration and respi